Genesys Co-sponsors Grief Teleconference on March 24

Genesee County, MI - The Hospice Foundation of America presents its 17th annual grief teleconference Wednesday, March 24, from 1:30 p.m. to 5 p.m. This year’s topic is “Living with Grief: cancer and end-of-life care.”

The teleconference will take place at the University of Michigan-Flint in the Happenings Room of the Harding Mott University Center.

Subjects covered include: care options related to cancer diagnosis, loss and grief reactions, psychosocial aspects of cancer, pain management, and ethical issues related to cancer.

This teleconference is designed for professionals working with end-stage cancer patients and families transitioning to hospice and palliative care; and for family members dealing with similar issues.

Following the teleconference, a live panel discussion will take place from 4 p.m. to 5 p.m., featuring the following experts in grief: Stuart Weiner, DO, medical director of Genesys Hospice and the Genesys Inpatient Palliative Care program; Sue Wedda, social worker who specializes in areas of mental health as they relate to grief and loss; and Carol Wikaryasz, Genesys Spiritual Care chaplain who works with cancer patients and families at Genesys.

The teleconference is free; cost to obtain continuing education credits is $25. Registration and a light lunch begins at 12:30 p.m.

The grief teleconference is sponsored by Genesys Home & Hospice Care, Avalon Hospice, Brown Funeral Home, Hill Funeral Home, Heartland Home Health Care & Hospice, McLaren Visiting Nurse and Hospice, and Riegle Funeral Home.

To register, call 1-800-664-6334.

Michigan Author to Hold Book Signing, Lecture About Cancer

Royal Oak, MI – Veronica Decker, a psychiatric nurse practitioner, specializing in cancer care, will hold a book signing and lecture this Saturday, September 19th, 2009 at Barnes & Noble, located at 500 Main Street, in Royal Oak. The signing will take place from 2-3:15 p.m. followed by a brief talk from 3:15 – 3:30 p.m.

“Coping With Cancer: A Patient Pocketbook of Thoughts, Advice, and Inspiration for the Ill” was written by Decker to help patients and their families manage a cancer diagnosis. This helpful guide covers such topics as doctor’s visits, crisis management, hope, family, friends and much more.

For more information regarding the author, her blog, or where to find her book, visit www.veronicadecker.com.

Reunion with a Cause in Holly benefits cancer patients

GENESEE COUNTY, MI – The sixth annual Reunion with a Cause to benefit Genesys cancer patients in financial need, will take place Friday, Aug. 14, from 6 p.m. to 10:30 p.m., at Holly High School’s track.

Sponsored in partnership with the Genesys Health Foundation and the Holly community, this annual event includes a cancer survivor walk and celebration, family activities, a candle lighting ceremony, music, entertainment and
refreshments. Those participating are encouraged to collect donations.

The evening begins with opening ceremonies featuring event co-chair Butchie Mackey, a Holly resident and one of the original organizers of this fundraiser; Mark Taylor, president and CEO of Genesys Health System; and an awards  presentation to the group who raised the most money at last year’s reunion event, and to other members of the community for their outstanding contributions to Reunion with a Cause.

After opening ceremonies, cancer survivors will walk a survivor “victory” lap.

Musical performances and enterainment follow throughout the evening from 7 p.m. to 9:30 p.m.

At 9:50 p.m, a luminary lighting ceremony begins to remember all those whose lives were lost to cancer.

Nick Evans, chief development officer and vice president of the Genesys Health Foundation, will conclude the evening with closing remarks.

Last year’s Reunion with a Cause yielded almost $54,000, a recordbreaking amount. These funds were used to help Genesys cancer patients pay for medication not covered by insurance, medical equipment, rental equipment such  as wheelchairs, private pay aides, transportation to and from cancer treatments, and other special needs not covered by health insurance.

“This annual event celebrates and commemorates those whose lives have been touched by cancer, while helping those who are in financial need,” reports Evans. “We welcome everyone in the community to participate in some way – by  making a donation, by walking the track in memory of a loved one, by standing on the sidelines applauding the efforts of others, or by bringing their families to enjoy the celebration or walk in the luminary walk.”

For more information on the Reunion with a Cause to benefit Genesys cancer patients, call the Genesys Health Foundation at 810-606-6020.

Genesys Athletic Club hosts “Shakin’ it for a Cause”

(GENESEE COUNTY, MI) Genesys Athletic (GAC) is hosting a Ladies Night Out, Friday, July 10, beginning at 6:30 p.m., to raise funds for cancer patients at Genesys.

“Shakin’ it for a Cause” will feature one hour of dance exercise that includes Zumba, belly dancing, hula and Bhangra (high energy folk dancing); drinks and appetizers; a guest pass to GAC; a live auction for a private Zumba party; raffles for a variety of prizes; and a t-shirt for the first 200 women who sign up. Cost is $30 a person.

All proceeds go to Reunion with a Cause, an annual event held at Holly High School to raise money for Genesys cancer patients.

Child care services at GAC are open to those who need them at a cost of $3 a child per hour. All of this money will go to Reunion with a Cause.

To register for “Shakin’ it for a Cause,” call Genesys Athletic Club at 810-606-7300.

Reunion with a Cause is an annual walk on the track of Holly High School. Sponsored by Genesys Health Foundation, this event includes an evening filled with family activities, a candle lighting ceremony to remember loved ones lost to cancer, music and refreshments. Last year, more than $53,000 was raised for Genesys cancer patients. This money was used to help cancer patients pay for medications, medical equipment, rental equipment such as wheelchairs, private pay aides, transportation to and from cancer treatments, and other special
needs not covered by health insurance.

This year’s Reunion with a Cause will take place Friday, Aug. 14. For more information on the fundraising walk at Holly High School, call the Genesys Health Foundation at 810-606-6020.

The Last Lecture

When Randy Pausch was diagnosed with pancreatic cancer at the age of 46, the Carnegie Mellon professor, husband and father of three, surely did not realize how his diagnosis would eventually take a path that eventually would affect millions of people around the world through his inspirational approach to life, love and death.

What began as a grim, personal diagnosis between patient and physician turned into a “last lecture” in front of 400 Carnegie Mellon students, to an inspirational column by Wall Street Journal columnist Jeff Zaslow, to a YouTube sensation, an appearance on Oprah, ABC News and a best-selling book, “The Last Lecture.”

And, by the time Randy Pausch lost his battle with cancer in July 2008, he had touched millions of lives across the globe simply by sharing a message about childhood dreams, but more importantly, a message to his wife and children.

In November, at an event held by the Beaumont Foundation, Zaslow spoke about his relationship with Pausch, the message that is found within the pages of his book, and how Randy’s legacy will continue to touch many people for years to come.

Zaslow, who is a graduate of Carnegie Mellon, received a call from the computer science department at his alma mater inviting him to come hear a lecture by one of their professors who would be giving a “last lecture” – which is a rite of passage that many professors give just before they retire. But, in this case, Pausch was dying.

“I called Randy on the phone the day before the lecture and he was so funny and engaging that I thought I would go,” says Zaslow. “The plane ticket from here (Detroit) was $800, so my editor said to just call (Randy) when it was over, but I found him very funny so I thought I would go check him out.”

The result of Zaslow’s 300-plus drive from Detroit to Pittsburgh turned into one of his columns in the Wall Street Journal and also fostered a new relationship with Pausch. The interest that sprouted from this story gained tremendous momentum, and the suggestion of a book came to light.

“He wasn’t sure if he wanted to do a book because he was dying,” says Zaslow, of Pausch. “And he wasn’t sure he wanted to do it with me because he didn’t know me that well and he said he didn’t want to take the time to do a book.”

However, a plan was put in place and Pausch decided he would speak to Zaslow while riding his bike for exercise each day. What followed was 53 days of Pausch riding his bike, headpiece in place, speaking to Zaslow over the phone, dictating his thoughts for “The Last Lecture.”

“The idea was to complete the book so that it would come out in his lifetime,” says Zaslow. “It came out in April.”

Zaslow believes the interest in Pausch’s story has captivated so many people because his lecture was “authentic.”
“When you are watching it…it’s like you are eaves-dropping,” says Zaslow. “It’s a guy talking to his work family, telling them to go out and do great things…he’s telling them, ‘I love you’ to all of his colleagues and students. So it’s real.”

Zaslow describes that despite Pausch’s grim diagnosis, he was the most alive person in the room when he was giving his lecture. “You can’t watch that video and not think, ‘oh my God, he’s just the greatest.’ So, the book is just a companion piece to the lecture, it’s different, but people just love it. There is something about Randy that just resonates with people.”

The path of the book begins and ends with Pausch on stage. In between, the pages reveal different parts of Randy’s life that molded him into the person he became, the lessons he learned, and the lessons he hoped to  pass on to his children, as well as those who read the book.

Pausch’s kids were 6, 3, and 2 when he passed away. He discusses in his book how he wants his children to be true to themselves in life. He reflects how his terminal diagnosis is not unfair to him; however, he feels it is terribly unfair for his children not to grow up with a father.

Zaslow says his life has changed forever since writing this book. “I have learned of the fragility of life. Just from knowing Randy my life has changed. I was sending him links to all of these websites and the thousands of emails we were receiving, and after sending these things for months and months, I got an email from Randy that said, ‘Will you stop Googling my name and go hug your kids!’”

“So, he knew how to distill everything into meaningful phrases,” says Zaslow.

Writing a book with a dying person would not be an easy venture, and Zaslow says there were moments of uneasiness while talking with Randy. “I knew this was a story of a lifetime, so I knew I wanted to do this more than he wanted to do it. He was dying. He could’ve taken it, or left it. It’s been an honor to tell his story.”

“He had a gift of telling things so that you weren’t thinking about him, you were thinking about yourself,” adds Zaslow. “He was depressed sometimes. He wasn’t a Superman. But he looked at each day and said, ‘how can I make the most of each day?’”

After developing such a close relationship over the months, Zaslow can’t help but miss his old friend.
“I miss that I can’t tell him what is going on today,” Zaslow reflects. “I get emails about him still -everyday.  My last email to him was about 9 days before he died,” Zaslow says. “He really lost interest in everything that was going on toward the end.”

In Pausch’s final days, he was weak, depressed and spent about 20 hours a day in bed, according to Zaslow. However, he was still giving lessons to his kids.
“His son, Dillon, came up to one of Randy’s friends the day after Randy died and said, ‘Is cancer solvable?’  And his friend said, ‘Well, some yes, some no.’ And, his son said, ‘Well my dad taught me that I have it within me to solve problems.’”

The lessons have already taken hold.

Breast Cancer Facts

October is the month where attention is focused on breast cancer awareness and fundraising. Nearly everyone has a friend, relative or loved one that has been diagnosed with breast cancer. Although treatments are improving every year, many women still die from this disease. The following are some tips and facts about breast cancer from the Barbara Ann Karmanos Cancer Institute in Detroit.

BREAST CANCER FACTS

• There are 2.5 million breast cancer survivors in the U.S. today.

• Globally, more than 1.1 million women will be diagnosed with breast cancer and more than 410,000 will die from the disease (projection for the year 2007).

• Globally, a case of breast cancer is diagnosed every 29 seconds. A woman dies from breast cancer every 75 seconds world wide.

• In the United States, a woman is diagnosed with breast cancer every 3 minutes. One dies every 13 minutes.

• One in 8 women in the U. S. will develop breast cancer in her lifetime.

• Breast cancer is the most common cancer among women.

• Breast cancer is the second highest leading cause of cancer death among women (after lung cancer) and the leading cause of cancer death among young women.

• Being a woman and getting older are the most common and most important risk factors for breast cancer.

• Thanks to improvements in early detection and treatment, breast cancer deaths among all women have steadily declined since 1991.

• Currently, there is neither a cure for this disease nor any known way to prevent it, making early detection key to survival. Early detection can be an extremely effective tool: if breast cancer is found and diagnosed while still confined to the breast, the 5-year relative survival rate is more than 98 percent.

• What’s more, timely screening mammograms could prevent 15 to 30 percent of all deaths from breast cancer in women over age 40.

BREAST CANCER DISPARITIES

• Although breast cancer continues to affect people from all backgrounds, there are significant differences within the mortality rates among racial groups.

• The grim news, however, is that low-income women have lower screening rates, are 41 percent more likely to be diagnosed with late-stage breast cancer, and are three times more likely to die from breast cancer, according to studies from the Institute of Medicine.

• Similarly, uninsured women are more likely to receive a late-stage breast cancer diagnosis and are 30 to 50 percent more likely to die from the disease than women with insurance.

• While white women have the highest breast cancer incidence rate (140.8. cases per 100,000 women) in this country, Black women have the highest mortality rate nationally (35.9 deaths per 100,000 women).

• From 2000-2003 African American women had a 36 percent higher death rate than other women, giving them the highest death rate and poorest survival rate of any racial or ethnic group for breast cancer.

• Although breast cancer mortality rates declined 2.6% annually between 1992 and 2000, the decline was twice as great for white women as for black women.

• However, African American women still have a higher breast cancer death rate (than Caucasian women) even though African American women develop breast cancer less often.

• While 90 percent of white women diagnosed with breast cancer survive for at least five years, only 77 percent of black women survive for that long.

• There is also evidence that tumors are more aggressive among black women than they are in white women.

• If you are an African American woman, you are less likely to develop breast cancer, but more likely to die from the disease than women in other groups. African American women have a 35 percent higher death rate than Caucasian women, even though they are less likely to get breast cancer.

• If you are a Hispanic or Latina woman you are morel likely to be diagnosed with breast cancer at a more advanced – and deadlier – stage. Only 38 percent of Hispanic women age 40 and older have regular mammograms.

• If you are an Arab immigrant beliefs and customs may discourage you from being screened. There may also be other practical barriers, such as language or transportation.

• If you are an Asian immigrant, language barriers may make it difficult for you to get screened and treated.

• If you are a Native American or Alaska native, you are less likely than women of any other ethnic group in the U.S. to be alive five years or longer after a breast cancer diagnosis. Only 37 percent of Native American women age 40 and older get mammograms.

• If you live in a rural community, you may have to travel long distances to find a screening facility or a clinic for treatment.

• If you are a lesbian or bisexual woman, negative experiences with the healthcare system may discourage you from seeking routine medical care, reducing your chances of finding breast cancer in its early, more treatable stages.

• If you are under age 40 and are at high risk for breast cancer, you are less likely to benefit from screening technology compared to older women because your breast tissue may be denser, making mammography less effective.

• If you are over age 70, you are less likely to receive the best available treatment.

• If you are a man, you are less likely to think it’s breast cancer if you find a lump in your breast and you may be diagnosed late.

• If you are disabled, you are less likely to be offered breast-conserving surgery instead of a mastectomy. You may also have mammograms less often than you should because screening facilities may not be able to accommodate your disability.

IN MICHIGAN

• American Cancer Society 2007 estimates: 5,900 Michigan women will be diagnosed with breast cancer and 1,320 women in the state will die from the disease.

• Thirteen percent or 410,808 non-elderly Michigan women are uninsured and do not have access to preventative health care services.

• African American women in Michigan are dying of breast cancer at a higher rate (34 per 100,000) than White women (23 per 100,000).

• Wayne County was identified in a Susan G. Komen for the Cure-commissioned report as one of eight U.S. communities with alarmingly high breast cancer mortality rates. In fact, because of gaps in access to quality care, African American women in Detroit die from the disease far more often than White women.

• The Michigan Breast and Cervical Cancer Control Program (MI BCCCP) pays for life-saving cancer screening services and follow-up care for including cancer treatment if that should be needed to under- and uninsured Michigan women. If current funding is maintained, it is estimated the program will still be able to reach only 20 percent of women who qualify.

Based in Detroit, Michigan, the Barbara Ann Karmanos Cancer Institute is committed to a future free of cancer. The Institute is one of 41 National Cancer Institute-designated comprehensive cancer centers in the United States. Caring for more than 6,000 new patients annually and conducting more than 700 cancer-specific scientific investigations programs and clinical trials, the Karmanos Cancer Institute is among the nation’s best cancer centers. Through the commitment of 1,000 staff, including nearly 300 faculty members, and supported by thousands of volunteers and financial donors, the Institute strives to prevent, detect and eradicate all forms of cancer. The Karmanos Cancer Institute was originally established in 1943 as the Detroit Institute for Cancer Research, which then became the Michigan Cancer Foundation. The Institute was renamed the Barbara Ann Karmanos Cancer Institute in 1995 in memory of the late wife of Peter Karmanos, Jr., chairman and CEO of Compuware Corporation. Barbara Ann died at the age of 46 after an eight-year battle with breast cancer. To learn more about the Barbara Ann Karmanos Cancer Institute, its services, or how you can get involved, visit www.karmanos.org or call (800) KARMANOS.

Contributed by: Barbara Ann Karmanos Cancer Institute

Ask the Doctor: July 2008

Question: I am 23 years old and my pap smear came back positive for HPV and had some abnormal cells. I am very worried about this. Can I still get the vaccine for HPV?

Answer: The vaccine for HPV (human papilloma virus) is marketed under the name Gardasil. When they studied the effectiveness of Gardasil before it was approved by the FDA, they studied women who were already infected with one strain of HPV. Gardasil contains the 4 strains of HPV most likely to cause cervical cancer and genital warts. The women who had previously been diagnosed with one strain of HPV were still protected from the other three strains, and the FDA has approved Gardasil for women who have already been infected with one strain. Make sure you talk to your gynecologist about getting the vaccine series. Also, make sure you are getting treated for the abnormal cells on your pap and you follow through with your repeat pap smears, as they will have to be more frequent than once a year of a while.

Question: Last month when you talked about screening for breast and ovarian cancer, you mentioned the CA-125 test. I have read about this in my women’s magazines, which say I should have it done, but my gynecologist has never ordered that test for me. Do I need this test done?

Answer: This is a great question and my patients ask about this test all the time. Ovarian cancer is a rare cancer, with most women only carrying a 1.7% lifetime risk (compared to 13.2% lifetime risk for breast cancer). Unfortunately, due to the location of the ovaries deep within the pelvis, it is difficult to screen for ovarian cancer, thus ovarian cancer is not usually found until it is at a later stage and is harder to cure. Many studies have been done, and no effective screening test has been found for ovarian cancer. The CA-125 blood test is supposed to be used after a woman is diagnosed with ovarian cancer, to follow to see if the cancer has come back. Not all women with ovarian cancer have a positive CA-125 before surgery, so this does not help all patients. In addition, not all patients with a high CA-125 have ovarian cancer, so the false positive rate is quite high; too high for a screening test. As an example, a patient of mine had severe pelvic pain, an ultrasound was done showing an ovarian mass and the CA-125 was very high, around 1700 (normal is less than 25). However, when she went into surgery the results showed that she did NOT have ovarian cancer, and she had endometriosis instead. She is a very lucky woman, but this just illustrates why we don’t use the CA-125 as a screening test for all women. All of that being said, for the women who are at very high risk for ovarian cancer, we have to screen somehow. For my patients with a first degree relative (mother, sister, or daughter) with ovarian cancer, I recommend a pelvic ultrasound every year to look at the ovaries and the CA-125 blood test. This however is not standard of care and generally not covered by insurance for screening purposes. With women that are such high risk, usually the expense is worth the possibly of early diagnosis and a chance at a cure. I would discuss your personal risk with your gynecologist and determine if the CA-125 is right for you.

Dr. Karen Lockwood is a graduate of University of Oklahoma College of Medicine.  She completed her residency in Internal Medicine at Henry Ford Hospital in Detroit.  She is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, Please email your question to askthedoc@healthandleisureonline.com.

*Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Acupuncture & Mainstream Medicine

With Beth Kohn, LAc

For thousands of years, the ancient practice of acupuncture has been a mainstay of traditional Chinese medicine. It is one of the oldest healing techniques in the world, and until recently has been niched for those practicing holistic medicine.

However, over the past several years, it has found its way into modern day medicine. Once taboo with many medical physicians, acupuncture is now being used as complementary treatment in areas such as cancer pain, infertility, dentistry and other areas.

The theory behind acupuncture is that the fields of energy within the body can be manipulated using solid, metallic needles, to stimulate healing within the body. This is based on the principle that the body has two opposing and inseparable forces, the yin and yang, that when appropriately balanced can lead to a healthy being. The needles used help connect the disrupted energies within the body and helps them reconnect along the meridians, which are lines between the points within the body.

Several large studies have been carried out over the past decade to understand the effects of acupuncture. The NIH (National Institute of Health) determined that many physicians were beginning to incorporate acupuncture as complementary treatment to certain conditions.

With the increased use of acupuncture, the FDA now regulates the production of acupuncture needles to certified, trained practitioners to ensure safety, sterility and quality of the needles.

“I find that most of my patients are looking for alternatives to pharmaceutical medicines,” says Beth Kohn, is a certified acupuncturist at the Henry Ford Center of Integrated Medicine, in Northville. “They want to find options with fewer side effects.”

The goal for both traditional western medicine and eastern medicine is the same; to help heal a patient’s ailment. Therefore, combining these two differing philosophies can see successful outcomes for many patients. By working in concert, the practitioners can provide quality outcomes for some of the most difficult of patient conditions.

“We try to figure out how we can use these therapies (acupuncture and herbal medicine) wen traditional western medicine and pharmaceuticals don’t work, or people can’t tolerate them,” says Kohn. “We have used traditional eastern medicine on people with neck pain, headaches, menopause and premenstrual syndromes. We work with the (physicians) to determine if it is okay to incorporate this into the patient’s treatment.”

Although there are still some skeptics to using acupuncture as complementary treatment, they are becoming fewer and fewer. In fact, many physicians are learning about these alternative therapies based on the demand from patients.

“Patients are more educated and do more research today. It used to be you would go to the doctor and ask what to do, and the doctor would take care of you. Today, people are doing research and coming to the doctor with alternatives and questions about herbs and other treatments,” says Kohn.

This patient-driven force is part of the reason that many hospitals within metro Detroit are now incorporating this integrative treatment plan in certain disease states.

One example of how the Center for Integrated Medicine worked with a physician involved a patient diagnosed with Hepatitis C, says Kohn. The patient had researched the disease and did not want to receive interferon treatment.

“I talked with the physician and found out where the patient was in the stage of his illness and discussed the patient’s desire to use alternative therapies. We made sure it wouldn’t be dangerous to the patient and the doctor said it was okay. Baseline blood work was done and we set up a three month treatment plan to see where the patient was after that time,” says Kohn. “We made it clear to the patient that if we didn’t see the results we wanted, then he was to move forward with the medical plan.”

Another large area of use of acupuncture and herbal medicine is in patients with cancer or those who have completed treatment, says Kohn. In particular, patients who survived breast cancer or ovarian cancer who can no longer receive estrogenic medications. “These patients want to try alternative therapies so we have the physicians review the herbs and move forward with the treatment,” says Kohn.

Although acupuncture is commonly thought to be used for those who are already sick, there are many people who receive treatments to stave off illness and keep healthy.

“Acupuncture is tapping into our natural ability to relax and heal,” says Kohn. “There is a natural release of endorphins and nerve stimulation. People who get acupuncture consistently report getting sick less and have immune systems that respond well to illness.”

Acupuncture is not covered by all insurances and it is important to consult with your insurance company to see what their policy is on treatment. You should also do your research to make sure that your therapist is certified by a nationally recognized organization before seeking treatment.

Although side effects are rare with acupuncture, there can still be serious consequences if you are not treated by someone who is well-trained.

Beth Kohn, Acupuncturist, L.Ac (CA), MTOM, Dipl. Ac., Dipl. CH is a Staff Acupuncturist at the Henry Ford Center for Integrative Medicine in Novi. She received her Masters Degree Oriental Medicine (MTOM)-Pacific College of Oriental Medicine, in San Diego, and her Bachelors of Science from the University of Maryland. She is California Board Certified in Licensed Acupuncturist & Chinese Herbalist and received her NCCAOM Certification in Acupuncture therapy (Dipl.Ac.), Certification in Chinese Herbal Medicine (Dipl.CH). She is a current member of the Michigan Association for Acupuncture and Oriental Medicine.

Ask the Doctor: January 2008

Question: I was watching Oprah and Dr. Oz mentioned that his favorite vitamin was vitamin D, and that a lot of people don’t get enough vitamin D. Why is that? I thought we got enough vitamin D from milk and the sun. – D.V., Grand Blanc

Answer: That is a great question! This topic has come up in a lot of conversations between me and my colleagues recently, and I agree with Dr. Oz. Vitamin D has been underrated for sometime.

The most common way that we get vitamin D is from the sun. When the sun hits your skin, it starts the production of vitamin D. Because of the shorter days and decreased intensity of the sun in the northern states and Canada, people living there (including the Detroit metro area) are more likely to be vitamin D deficient. Also, with the concern about skin cancers increasing, more people are using sunscreen and thus preventing the formation of vitamin D in the skin. Most dermatologists recommend a sunscreen with at least an SPF of 15 to prevent skin cancer; however an SPF of 8 will block enough of the sun’s rays that your skin will not make vitamin D.

Vitamin D can also be obtained through the diet. As most people know, milk is fortified with vitamin D. However, the vitamin D in milk breaks down easily, and by the time you have consumed about half of the milk in the carton, the vitamin D is no longer there. The other source of vitamin D in food is fatty fish like salmon or tuna. Of course, salmon and tuna contain many other important nutrients, like omega-3 fatty acids, so anytime you can eat these fish is good.

You can also get vitamin D from your multivitamin or over-the-counter supplement. Most doses of vitamin D in multivitamins are based on the recommended daily allowance, which we are now realizing is too low. The current recommendations for daily vitamin D intake was based on the amount of vitamin D needed to prevent rickets in children, which is not enough to prevent a variety of problems in adults.

The reason that we are so concerned about vitamin D now is that it is related to many common and serious illnesses. Vitamin D deficiency contributes to osteoporosis in post-menopausal women and can explain why some women still have hip fractures even when they are on medications to prevent fractures.

Vitamin D deficiency can cause muscle weakness and may contribute to the symptoms of arthritis. Vitamin D deficiency can also make the achiness that comes with the cholesterol medications known as “statins” worse. Before you stop your cholesterol medication because of aches and pains, ask your doctor to check your vitamin D level and replace the vitamin D if necessary. Your aches should improve as your vitamin D level goes up.

Vitamin D helps to keep cells healthy, and a vitamin D deficiency is linked to an increased risk of cancer. Those cancers that can be affected by vitamin D levels are colon, pancreatic, prostate, ovarian, and breast cancer. The risk of Hodgkin’s lymphoma is also increased by low levels of vitamin D. Vitamin D deficiency increases the risk of diabetes type 1, crohn’s disease and multiple sclerosis. Low levels of vitamin D can increase the risk for heart disease by mildly increasing blood pressure and increase inflammatory markers that are linked to heart disease, such as C-reactive protein.

Vitamin D deficiency can also contribute to depression. One of the theories behind seasonal affective disorder is that it is related to low vitamin D levels in the winter months. Seasonal affective disorder is related more to the amount of light during the day rather than the temperature, so the vitamin D theory may hold to be true.

The next time you go in for a physical or for blood work with your doctor, ask about having your vitamin D level checked. The normal range currently is 20-80, with anything below 10 considered to be severe deficiency. However, we find that people do better with levels higher than 20, so I treat my patients who have vitamin D levels less than 32. With clinically deficient patients, I am replacing their vitamin D aggressively with 50,000 IU once a week for 8 weeks, and then repeating the level check. Once the vitamin D level is above 32, the 50,000 IU tablet only needs to be taken once a month.

If you are vitamin D deficient, you will need to take supplements for the rest of your life. Over the counter formulations of vitamin D come in 1000 IU tablets. The 50,000 IU tablet is available by prescription from your pharmacy. Once you are back into the normal range, you could also take two over-the-counter tablets daily instead of the prescription monthly dose.

If you are not vitamin D deficient, taking the over the counter formulation once or twice a day can help you maintain your healthy levels. It is almost impossible to overdose on vitamin D, so if you want to take the supplement before having your level checked, go ahead. Taking vitamin D is an excellent way to prevent a number of serious diseases with a simple natural supplement a day.

Dr. Karen D. Lockwood is board-certified in Internal Medicine and is currently in private practice in Troy, MI.

If you would like to submit a medical question to Dr. Lockwood, please email your question to: askthedoc@healthandleisureonline.com

* Advice found within this article is for informational purposes only and should not replace the advice or recommendations of your physician.

Diagnosis: Breast Cancer – But What About My Breasts?

The odds are that one in nine women will get breast cancer in their lifetime. Those are staggering numbers.

Once a diagnosis of breast cancer is made a whole team of specialists get involved to guide the patient through the treatment choices. What essentially determines your prognosis and treatment is your staging of the disease – the worse (of higher) the staging, the more aggressive the treatment.

There are essentially a combination of treatments ranging from chemotherapy (including hormone blockers), radiation and surgery that can be used. The best determination will depend on age, stage, certain hormone receptors of the disease and family history.

A majority of women will probably not need plastic surgery because the disease, if caught at an early stage, can be treated with lumpectomy and possible radiation and/or chemotherapy. If these treatments are done then a woman preserves her own breasts and the cosmetic result is excellent.

For those whose treatment regimen may include a total mastectomy the question is, “What about my breasts???”

For women who have more advanced disease, the best treatment may be a mastectomy with or without lymph node sampling. At this stage a thorough consultation with a plastic surgeon is required prior to the mastectomy so that reconstruction can be done simultaneously while in the operating room.

The first meeting should include a thorough history and physical exam. A plastic surgeon will consult with his or her colleagues regarding the type of mastectomy, the staging of the disease and whether post operative radiation or chemotherapy may be used. Most importantly, the patient is examined for the risk of surgery and reconstruction. Is she healthy, does she smoke, are there comorbidities? During the interview, the plastic surgeon will ask whether the patient wants to do reconstruction at all or does she want reconstruction with her own tissue or using implants and other materials.

Some patients that get mastectomies at an older age or have severe comorbidities may not be candidates for aggressive reconstruction. If a patient has aggressive disease and requires radiation, then reconstruction may be delayed for a while until her disease is better controlled.

So what are the options?

OPTION 1: Bypass reconstruction and possibly be fitted for an external prosthesis.

OPTION 2: Reconstruction using your own tissue.

This may require we use the muscle and skin from your back, tummy or buttocks. It may be done as a flap with an artery supply that is intact and simply moved or the blood supply is interrupted and reanastomosed under a microscope (free flap). Sometimes an implant may be needed to get proper size.

Reconstruction using your own tissue (autologous) gives the most natural feel and look to the breast but the trade off is another site of surgery including a scar, longer surgery, more prolonged recovery and possible revisions in both the donor site and the mastectomy site. The transferred tissue may need to be trimmed and revised. Once the proper look is achieved a nipple will have to be reconstructed and tattooed. Also the other breast may have to be augmented and/or lifted or reduced to achieve symmetry. If radiation is used post-operatively then autologous reconstruction is delayed for a while.

OPTION 3: Reconstruct with implants.

Usually a tissue expander is placed at the same time as the mastectomy and expanded post operatively to a desired result. Then the patient is brought back in after a couple of months or after chemotherapy and/or radiation and a permanent implant is inserted. The implant may be saline or silicone. The risks and benefits of both implants can be discussed with your doctor. As with any reconstruction the other breast may be augmented and/or lifted or reduced. Finally, a nipple on the reconstructed breast will have to be made and tattooed. In some instances a muscle may be harvested to add to the reconstruction. Lately to reduce the morbidities, Alloderm (cadever dermis) can be used to substitute for the muscle.

Every patient, regardless of staging, age or comorbidities has to make wise and educated decisions both for their treatment as well as their reconstruction. Whether the reconstruction is done during the initial mastectomy or delayed for a time can be dependent on the disease and subsequent treatment. It may be wiser to treat the disease and then reconstruct once the patient has had chemotherapy and/or radiation. The resultant reconstruction will not be affected by these modalities as much.

All surgeries carry risk and a qualified board certified plastic surgeon can discuss the risks, treatments and possible choices in a simple yet thorough matter.

Dr. Ayoub Sayeg is a Board Certified Diplomate, American Board of Plastic Surgery, Cosmetic and Breast Fellowship Trained. He received his medical degree from the University of Toronto and served his general surgery residency at Washington Hospital Center, Washington, D. C. Dr. Sayeg served his plastic surgery residency at Wayne State University in Detroit from 1998 to 2000.

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